Communication breakdown: clinicians disagree on subacromial impingement

Abstract

"Subacromial impingement syndrome (SIS)" is often used as a diagnostic label, but has become more controversial as such in the literature. We assessed views on SIS in clinical practice using a survey with 63 0-10 VAS items among orthopedic surgeons and physical therapists from the United States and the Netherlands. Multivariate regression and cluster analyses were applied to identify consensus items and to study profession and/or nationality effects on item ratings. Most items received neutral or highly variable ratings. Twenty-nine were considered associated with SIS, including worsening of pain with overhead activities, painful arc and a positive Neer's test. Seven items were regarded pleading against SIS, including loss of passive motion. Activity modifications and physical therapy are the most important treatments according to therapists, who highly valued motion-related etiologic mechanisms. Surgeons, with higher ratings for intrinsic and anatomic etiologies, appreciated the use of subacromial corticosteroids and surgery. Clinicians from different professional backgrounds have different views on what SIS is, and even within professional groups, variations are substantial. This has to be taken into account when communicating about SIS symptoms, for example, in intercollegial consultation or scientific research. The authors suggest cautious use of (subacromial) impingement syndrome as a diagnostic label.